<div class="row">
  <form action="/apply", method="POST">
    <div style="margin-left: 18px;
    background-color: #ffffff;
    padding-top: 5px;
    padding-bottom: 5px;
    padding-left: 10px;">
	<h5>你拥有 {{ customer.salary }}元</h5>    
</div>

    <div class="form-group">
      <label class="col-sm-2 control-label">提取 (￥)</label>
      <div class="col-sm-10">
	<input type="number" id="exchangeAmount"  min="1" max="{{ customer.salary }}" name="amount" class="form-control">      
</div>
      <div class="correct" id="exchange" data-exchange="{{dConfig.value}}" data-total="{{customer.salary}}"  style="display: none" ></div>
    </div>
    <div class="form-group">
      <label class="col-sm-2 control-label">真实姓名</label>
      <div class="col-sm-10">
        <input type="text" name="name" class="form-control">
      </div>
    </div>
    <div class="form-group">
      <label class="col-sm-2 control-label">支付宝帐号</label>
      <div class="col-sm-10">
        <input type="text" name="account" class="form-control">
      </div>
    </div>
    <div class="form-group">
      <label class="col-sm-2 control-label">手机号</label>
      <div class="col-sm-10">
        <input type="text" name="phone" class="form-control">
      </div>
    </div>
    <div class="form-group">
      <label class="col-sm-2 control-label">备注</label>
      <div class="col-sm-10">
        <textarea rows="4" cols="50" class="col-sm-10" name="remark"></textarea>
      </div>
    </div>
    <div class="form-group">
      <div class="col-sm-offset-2 col-sm-10">
        <button type="submit" id="exchangeSubmit"  class="btn btn-info col-xs-12">提交</button>
      </div>
    </div>
  </form>
</div>
{{> alertmodal }}
{{> extractConfirm }}
